1. A nurse is scheduling a clients medications. The client is ordered to receive a daily dose of fluoxetine (Prozac). Because of the major side effects of this medication, the nurse correctly scheduled this medication at:

a.

0800.

b.

1200.

c.

1700.

d.

2200.

ANS: A

This medication, an SSRI, may cause insomnia, so it should be given early in the day.

4. A nurse works in an assisted living setting. The nurse is administering a selective serotonin reuptake inhibitor to an 84-year-old client. The nurse is aware that the daily dose of this medication for the older adult client would be _____ the adult dose.

8. A nurse is scheduling a clients medications. The client is ordered to receive a daily dose of amitriptyline (Elavil). Because of the major side effects of this medication, the nurse correctly schedules this medication at:

a.

8:00 AM.

b.

12:00 PM.

c.

5:00 PM.

d.

10:00 PM.

ANS: D

This medication, a tricyclic antidepressant, may cause sedation, so it should be given at bedtime.

9. A client is on maintenance lithium therapy for bipolar disorder. The client enters the emergency department complaining of tremors. The client appears to be giddy and confused. A serum lithium level is drawn and is found to be 2 mEq/L. The nurse would anticipate:

a.

holding the next dose of lithium.

b.

administering the next dose of lithium at the next scheduled time.

c.

administering the next dose of lithium STAT.

d.

administering a dose of lithium double the normal dose.

ANS: A

This serum lithium level is above therapeutic range and the client is demonstrating symptoms of early lithium toxicity. The next dose would be held.

11. The client has been treated with antidepressants for mild depression for 3 years. The client says her medication is no longer working, and she states that she has heard that MAO inhibitors are effective medications in treating depression. The nurse would respond based on the knowledge that:

a.

there are few side effects with this medication.

b.

this medication requires significant dietary restrictions.

c.

this medication is relatively ineffective for depression.

d.

this medication causes hypertensive crisis.

ANS: B

MAO inhibitors, when eaten with aged foods (such as some cheeses and wines) and foods with tyramine, can cause hypertensive crises.

14. A client is taking fluoxetine (Prozac) for mild depressive disorder. The nurse is providing teaching and counseling. The client complains of lack of sexual desireand diminished sexual arousal. The nurses response is based on the fact that:

a.

this is a known side effect and may require intervention.

b.

this side effect will go away in 1 to 2 weeks.

c.

this is a side effect of depression, not of medication.

d.

clients may stop the medication on days they want to have sex.

ANS: A

This side effect is expected of the SSRIs and may require specific interventions and counseling.

15. The client is on medication for hypertension as well as a monamine oxidase inhibitor. The highest priority instruction that the nurse should give to the client regarding supplements or herbal preparations is to avoid:

a.

food with brewers yeast.

b.

food containing garlic.

c.

ginger supplements.

d.

feverfew supplements.

ANS: A

An increased use of brewers yeast with MAOIs can increase blood pressure.

18. The client has been started on Elavil. He tells the nurse that he does not take any other medication except for St. Johns wort, which he has found to be mildly therapeutic. What should be the nurses highest priority response to this information?

a.

The combination of Elavil and St. Johns wort can be particularly therapeutic.

b.

Use of St. Johns wort can cause the dosage of Elavil to require increase.

c.

Use of St. Johns wort can cause the Elavil to be completely ineffective.

d.

The combination of St. Johns wort and Elavil can produce serotonin syndrome.

ANS: D

When Elavil is combined with St. Johns wort, serotonin syndrome can result.